The Summer Season is Here

Summers in the great Pacific Northwest brings out the adventurous side in all of us.

Sports activities like kayaking and kiteboarding on the Puget Sound as well as hiking, cycling, running, sky diving, and mountain biking all things we like to take advantage of while the weather cooperates with us. Physical activity is a great way to keep the mind and body healthy and fit.

Preventing sports injuries so you can enjoy the summer takes some preparation, including assessing your current fitness level and any risk factors or pre-existing conditions. Ways to prevent summer sports injuries include:

• Annual physical exam – The healthier you are, the better you are at participating in a sports activity.

• Proper equipment and sports activity training – Check your equipment and get some simulated practice time in so that you get a feel for the sports activity as well as building up your aerobic endurance on the off season.

• Hydrating properly before and after a sports activity.

• Proper understanding of your playing field – “Lay of the land” for all sports activities can be tricky if you have never been to an area before and are attempting your first adventure sports activity like kiteboarding.

If it’s paddling down Columbia Gorge, kiteboarding on the Puget Sound or mountain biking on Tiger Mountain, remember, good preparation before attempting an adventure or high risk sport will help in preventing future injuries.

If you believe you are suffering from a sports injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.

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Patients, who have been suffering from chronic arthritis throughout their lives, have a new treatment option worth investigating. The new treatment is one Dr. Peterson is proud to be offering to his patients. Patients, that could not find relief before, may find relief with Gel-One. Zimmer Corporation, the company that developed Gel-One, created a brand new single use injection that is unlike the older ones on the market. This product has no false injections into the knee.

Out with the Old – Hyaluronic Acid Injection Therapy

The current treatment method, when used in patients who have had their arthritis for over a decade, has only around a 50 percent chance of actually relieving the pain of arthritis of the knee for an extended period of time. Those who find success with it have relief that lasts approximately 6 months, on average.

A second aspect of the current method of treatment is that even if the hyaluronic acid injection is successful in providing relief, some methods of therapy require a patient undergo multiple injections weekly, typically three to five per week depending on the severity of the arthritic pain.

In with the New – Gel -One

The Gel-One product by the Zimmer Corporation is not the first single-use injection treatment to be offered on the market. The previously used injection often provided an amount to be injected that was not sufficient to properly reduce pain and inflammation in the knee, producing what is affectionately called a pseudosepsis (fake infection). The Zimmer Corporation has worked hard to counter this first injection option by working to produce one that is much more effective while being processed in a way that still allows for delivery in a single use injection system.

Gel-One however has been clinically tested in a controlled study group to confirm that it does not produce a pseudosepsis effect.  The study consisted of 379 randomized patients, which 248 of them receiving the Gel-One formula. The patients were compared to the control at the thirteenth week beyond the baseline and demonstrated a greater amount of pain relief, averaging out at approximately 40% reduced amount of pain.

Also in this study there were no unexpected side effects observed, lending to the confidence our clinic has in this product as a new therapy option for those with chronic arthritic pain.

Gel-One and Our Clinic

Dr. Peterson offers Gel-One to his patients, and early results seem promising. He is continuing to use other forms of hyaluronic acid for those patients who have done well with them, and prefer not to switch.

If you would like to discuss your arthritis treatment options and find out if Gel-One is  right for you, make an appointment with Dr. Peterson at Orthopedic Specialists of Seattle. OSS is a comprehensive orthopedic practice.

Over the last decade, direct anterior approach (also called anterior supine incision or ASI) total hip replacement has been gaining popularity in the United States.  The reasons for this surge in popularity can be traced to three factors.

More traditional posterior or anterolateral surgical approaches to total hip replacement have to cut muscles attached to the hip joint in order to expose the joint.  In ASI total hip replacement, no muscles are cut, which results in less initial postoperative pain and faster early recovery with a shorter hospital stay for many patients.  Most patients have a one-night stay after surgery, and are off crutches by about 2 weeks after surgery.

The ASI approach allows for the use of x-ray imaging during surgery to precisely position the components, and to ensure very accurate measurement of leg lengths.  Since component position is critical to optimal long-term function of the implant, and leg-length inequality is one of the most common reasons for repeat surgery after older methods of hip replacement, this use of precise x-ray control is very advantageous.

Dislocation of the prosthesis is one of the more frustrating and challenging complications of total hip replacement.  With other techniques, the reported rate of dislocation over the lifetime of the prosthesis is 3-5% (Medicare data).  To try and minimize this, many surgeons performing those older techniques will tell their patients never to bend more than a right angle at the waist, and not to scissor their legs.

Because no muscles are cut during the ASI approach, the dislocation rate is markedly less.  After more than 2000 total hips performed by surgeons at Orthopedic Specialists of Seattle, the dislocation rate is less than 0.1% (less than 1 in 1000).  We therefore put no restriction on patient motion after surgery.  Dr. Peterson’s only restriction for his patients is no running for exercise.

An excellent YouTube animation video of how the ASI approach is performed is available below. While this video was made in Omaha by Dr. Ajoy Jana, the technique used by Dr. Peterson is very similar in all regards.

The surgeons at OSS perform more ASI hip replacements than any other practice in the Northwest.  Dr. Peterson has been performing total hip replacements for over 20 years, and switched to the ASI approach for most cases several years ago after seeing the significant benefits for his patients.  He would be happy to discuss this remarkable new technique with you during your office visit.

A hammertoe is a deformity of either the second, third, or fourth toe. The toe becomes curled at the middle joint, resembling a hammer. Hammertoes can be classified as flexible (able to be easily straightened) or fixed (unable to be straightened). You may notice skin irritation or calluses where shoes rub the top of the toe.

What causes hammertoe?

The most common cause of hammertoe is wearing improper footwear, particularly shoes that are too tight in the toe box. Tight shoes force the toe to stay in a bent position. This causes the muscles to tighten and the tendons to shorten. When left in this position for extended periods of time, the toe muscles can no longer straighten appropriately. High heels can also cause hammertoe because they push your toes forward and crowd them in the toe box. Other causes of hammertoe include trauma, abnormal foot mechanics due to nerve and/or muscle damage from diabetes, arthritis, and stroke.

What is the treatment for hammertoe?

The first line of treatment includes lifestyle changes and conservative remedies when possible. Wearing proper footwear and low-heeled shoes with a deep toe box help. Also, you should choose a shoe made of flexible material with a half-inch space between your longest toe and the inside of the tip of the shoe. Additionally, there are exercises you can do to strengthen your toe muscles, like picking up marbles with your toes.

There are many cushions, straps, and non-medicated pads to relieve your toe symptoms, and your orthopedic foot and ankle surgeon can advise you on which of these suit your individual problem. Talk with your doctor before you attempt self-treatment to be sure that you are choosing the right measure.

Can surgery help my hammertoe?

Surgery is indicated for fixed hammertoe deformities that are painful. Surgery typically involves removing the middle joint of the toe (where the deformity exists) and fusing the toe into a straight position. Sometimes the tendon that pulls the toe up must be lengthened if it prevents complete correction of the deformity. Your orthopedic foot and ankle surgeon will discuss the appropriate procedure for your hammertoe condition. Surgery is typically done on an outpatient basis and can be done with local anesthetic if desired.

I initially looked at switching to the anterior approach (going into the hip from the front rather than the side or back of the hip) because the PAs (physician assistants), nurses, and physical therapists in my hospital all told me that they felt that the patients who had anterior approaches were having significantly less pain and were able to rehabilitate faster.

I have a partner who was one of the first people in the Seattle area to do anterior approach THR and the hospital staff could watch the difference in how the patients recovered after their surgery.

Anterior Approach

Finally one day I asked our head PA how she would want her total hip done and she said definitely by the anterior approach. At that point I knew I had to learn more about it and whether it was reasonable for a surgeon that has always done THR through a posterior approach to change to a dramatically different technique and still be confident that my patients would benefit.

I first observed the technique in the operating room and then studied the anatomy of the anterior approach. The first obvious benefit is that the approach to the hip from the front is anatomically easy and does not involve cutting any major structures to get to the hip. You simply spread the interval between two muscles and you are down onto the hip capsule.

When you go in from the back you have to divide the gluteus maximus (butt) muscle and split part of the ilio-tibial band on the side of the hip and then cut several small tendons off the back of the hip.

The thing that stops a lot of surgeons from doing this approach is that it is so different from what they are used to. The other thing that stops them is the special technique that is necessary to place the stem into the femur (upper thigh bone). When you approach the hip from the back, it is fairly easy to place the stem of the implant into the femur.

From the anterior approach most surgeons use a special table called a fracture table that allows you to position the leg in a very specific way. In my case, all of the operating room staff and my assistants were used to doing this approach and that made my job a lot easier.

Once I decided that I wanted to learn this technique, I went to a lab where you can practice on cadavers. I was surprised at how easy the approach was and how well I could get good exposure of the socket and the femur to do the surgery. Once I had the exposure, the actual placement of the implants was exactly what I had been doing from the posterior approach.

I have now been doing all of my hips using the anterior approach, and although the first few that I did made me a little anxious, after about 10 hips I knew that I would never go back. For me to switch, I had to feel that it was an advantage to my patients and that I could do as good or better job implanting the components. I have definitely found both to be true.

I have found that my patients have less pain and are ready to leave the hospital sooner. After an anterior hip there are no hip position precautions like there are after a posterior approach. This means no pillows between the legs and you can bend over as far as you want.

My patients who have had one hip done through the posterior approach and one through the anterior approach tell me that not having to follow specific hip position precautions is one of the biggest positive differences that they noticed and they feel that it helped them recovery more quickly.

From my standpoint as a surgeon, I love the approach because I don’t have to cut any major structures to get to the hip, and also when it is done through the anterior approach it is easy to use fluoroscopy (real time x-ray) to check the position of the hip components while you are putting them in. This allows the cup position to be optimal and allows the surgeon to check the leg length to be sure it is the same as the other leg.

I am very happy that I was pushed to learn this new approach to THR. Total hip replacement surgery is one of the most rewarding surgeries that we do. No matter how it is done, as long as it is done well, patients have wonderful results. This is exactly why many surgeons don’t feel the need to change. They are doing an operation with excellent results and they don’t want to take a chance on having problems while learning a new way of doing it.

Fortunately for me, I was able to see a good surgeon and support staff doing this procedure and it convinced me to change.

My last thoughts for anyone reading this who is contemplating having their hip replaced is to know that the most important thing for a successful hip replacement is having a good surgeon and a hospital that does hip replacement surgery routinely. I do think the anterior approach has advantages over the posterior approach for both the patient and the surgeon and that’s why I switched.